Provider Demographics
NPI:1124164256
Name:BUCKS COUNTY ORAL AND MAXILLOFACIAL SURGEONS PC
Entity type:Organization
Organization Name:BUCKS COUNTY ORAL AND MAXILLOFACIAL SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:DESALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-348-0909
Mailing Address - Street 1:467 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3403
Mailing Address - Country:US
Mailing Address - Phone:215-348-0909
Mailing Address - Fax:215-348-3004
Practice Address - Street 1:467 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3403
Practice Address - Country:US
Practice Address - Phone:215-348-0909
Practice Address - Fax:215-348-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028368L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA595292Medicare ID - Type Unspecified